A study of the validity of the scaled version of the General Health Questionnaire in paralysed spinally injured out-patients

Associations between physical activity, mental health concerns, eating disorder symptoms, and emotional intelligence in adolescent athletes transitioning from COVID-19

BACKGROUND

It is well known that COVID-19 significantly disrupted the routines of school sports for adolescent athletes. In transitioning from this "change event," athletes may need support with resuming their pre-pandemic level of activities, and addressing their ongoing mental health concerns, including exacerbated eating disorder symptoms. Emotional intelligence (the ability to understand emotions, influencing decisions and motivation) is a factor that has not yet been studied during this transition, but may serve as a coping mechanism for altered physical activity, mental health, and eating disorder symptoms.

METHODS

Participants of the study included 315 Iranian adolescent athletes who transitioned back to 1 of 10 sports post quarantine restrictions (January 2022-January 2023). Physical activity and related stages of motivation for behavioral change were assessed by the Physical Activity Stages of Change Questionnaire, mental health concerns were assessed by the General Health Questionnaire-28, eating disorder symptoms were assessed by the Eating Attitudes Test-26, and emotional intelligence was assessed by the Schutte Self-Report Emotional Intelligence Test.

RESULTS

A three-way Multivariate Analysis of Variance (MANOVA) was conducted in order to test the overall differences between the 5 physical activity and behavioral change motivation groups (Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance) on each of the 3 health measures (mental health concerns, eating disorder symptoms, and emotional intelligence); significant main effects were found for each measure. Fischer's Least Significant Difference Post-Hoc Test indicated that there were significant differences between the Pre-Contemplation and Preparation groups, as well as the Preparation and Action groups, on all of the health measure mean variable scores, which contributed to the MANOVA significant main effects.

CONCLUSIONS

Participants in the Pre-Contemplation group (not intending to make behavioral changes within the next 6 months) had less mental health, higher eating pathology, and lower emotional intelligence, compared to participants who were in the Preparation group (intending to make behavioral changes within the next 1 month). Similarly, participants in the Preparation group had less mental health, higher eating pathology, and lower emotional intelligence, compared to participants who were in the Action group (has made specific, overt behavioral changes within the preceding 6 months). Overall, the findings from the current study highlight the need for sports professionals working with adolescent athletes transitioning from COVID-19 to monitor these aspects of mental, eating, and emotional health. Given that those in earlier motivation stages had more health concerns compared to those in later stages, professionals should encourage progression from the Pre-Contemplation to Action/Maintenance stage in order to improve health outcomes.

Diagnostic accuracy and feasibility of depression screening in spinal cord injury: A systematic review

Context: Individuals with spinal cord injury or disease (SCI/D) are at increased risk of depression, which is associated with poor short- and long-term outcomes. Accurate diagnosis is complicated by overlapping symptoms of both conditions, and a lack of consensus-derived guidelines specifying an appropriate depression screening tool. Objective: To conduct a systematic review to: (1) identify the diagnostic accuracy of established depression screening tools compared to clinical assessment; and, (2) to summarize factors that influence feasibility of clinical implementation among adults with SCI/D. Methods: A systematic search using MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane databases using the terms spinal cord injury, depression or mood disorder, and screening or diagnosis identified 1254 initial results. Following duplicate screening, five articles assessing eight screening tools met the final inclusion and exclusion criteria. Measures of diagnostic accuracy and feasibility of implementation were extracted. The Quality Assessment Tool for Diagnostic Accuracy Studies 2 (QUADAS-2) was used to assess study quality. Results: The Patient Health Questionnaire-9 (PHQ-9) had the highest sensitivity (100%), and specificity (84%). The 2-item version, the PHQ-2, comprised the fewest questions, and six of the eight tools were available without cost. Utilizing the QUADAS-2 tool, risk of bias was rated as low or unclear risk for all studies; applicability of the results was rated as low concern. Conclusion: The PHQ-9 is an accurate and feasible tool for depression screening in the adult SCI/D population. Future studies should evaluate the implementation of screening tools and the impact of screening on access to mental health interventions.

Contributions of physical and cognitive impairments to self-reported driving difficulty in chronic whiplash-associated disorders

STUDY DESIGN

Cross-sectional.

OBJECTIVE

To conduct a preliminary analysis of the physical, cognitive, and psychological domains contributing to self-reported driving difficulty after adjusting for neck pain, dizziness, and relevant demographics in chronic whiplash-associated disorders (WAD) using hierarchical regression modeling.

SUMMARY OF BACKGROUND DATA

Pain is a risk factor for car crashes, and dizziness may affect fitness to drive. Both symptoms are common in chronic WAD and difficulty driving is a common complaint in this group. Chronic WAD is often accompanied by physical, cognitive, and psychological impairments. These impairments may contribute to self-reported driving difficulty beyond neck pain, dizziness, and relevant demographics.

METHODS

Forty individuals with chronic WAD participated. Dependent variables were the magnitude of self-reported driving difficulty assessed in the strategic, tactical, and operational levels of the Neck Pain Driving Index. Three models were developed to assess the contributions of independent variables (physical, cognitive, and psychological domains) to each of the 3 dependent variables after adjusting for neck pain intensity, dizziness, and driving demographics. The measures included were: physical domain-range and maximum speed of head rotation, performances during gaze stability, eye-head coordination, and visual dependency tests; cognitive domain-self-reported cognitive symptoms including fatigue and the trail making tests; and psychological domain-general stress, traumatic stress, depression, and fear of neck movements and driving.

RESULTS

Symptom duration was relevant to driving difficulty in the strategic and tactical levels. The cognitive domain increased statistical power to estimate the strategic and operational levels (P < 0.1) beyond other contributors. The physical domain increased statistical power to estimate the tactical level (P < 0.1) beyond other contributors.

CONCLUSION

Physical and cognitive impairments independently contributed to self-reported driving difficulty in chronic WAD beyond neck pain, dizziness, and symptom duration.

LEVEL OF EVIDENCE

3.

A systematic review of depression and anxiety measures used with individuals with spinal cord injury

STUDY DESIGN

A systematic review.

OBJECTIVES

To review and assess the psychometric properties of depression and anxiety instruments used with populations with spinal cord injury (SCI).

SETTING

Vancouver, Canada.

METHODS

Electronic databases were searched for papers reporting psychometric properties of depression and anxiety instruments. Pre-established criteria were used to assess the psychometric properties.

RESULTS

Thirteen papers reporting on the psychometric properties of 13 depression and anxiety instruments are used in this review, and include BDI, BSI, CESD-20, CESD-10, DASS-21, GHQ-28, HADS, Ilfeld-PSI, MEDS, PHQ-9, PHQ-9-Short, SCL-90-R, and the Zung SRS. Reliability data are available for 10 instruments, and validity results are available for 12 instruments. Evidence spanned the spectrum of evaluation criteria varying from poor to excellent. Responsiveness data are generally lacking.

CONCLUSION

Given that the reliability and validity findings range for the most part from adequate to excellent, and the large amount of work to develop cutoff scores specific for populations with SCI, at present there is no need to develop SCI-specific instruments. As psychometric properties of one measure do not clearly stand out, it is difficult to recommend the use of one over another. Overall, more psychometric data are needed, and if the instruments are to be used to evaluate treatment outcomes or change over time, responsiveness data are also required. Administering the instruments in tandem with each other and with clinical diagnostic interviews would provide valuable information, as would comparison of results to normative data specific to individuals with SCI.

The Measurement of Disability-Related Stress in Wheelchair Users

OBJECTIVE

To measure disability-related stress through the development of the Physical Disability Stress Scale (PDSS) for wheelchair users.

DESIGN

Cross-sectional.

SETTING

General community.

PARTICIPANTS

Sample of 119 wheelchair users with an acquired physical disability.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

General Health Questionnaire-28 (GHQ) and the World Health Organization Quality of Life (WHOQOL-BREF) (Australian version).

RESULTS

Factor analysis of PDSS items revealed 4 main factors of disability-related stress: access accounted for 33.7% of the variance, physical for 8.4% of the variance, social for 7.9% of the variance, and burden of care for 7.2% of the variance. Internal consistencies for the 4 factors were within acceptable ranges (alpha range, .78-.83). Concurrent validity was shown with the PDSS factors predicting 7% to 23% of the variance in GHQ subscales and total score and 12% to 31% of the WHOQOL-BREF subscales. Participants scoring in the GHQ psychiatric group showed significantly higher stress levels on the physical, social, and burden of care factors of the PDSS compared with the GHQ nonpsychiatric group.

CONCLUSIONS

The results suggest the PDSS factors are valid measures of disability-related stress with potential for clinical and research applications. Confirmatory factor analyses with larger sample sizes of wheelchair users are required to establish consistency in the measurement of disability-related stress.

Schemata as moderators of clinical effectiveness of a comprehensive cognitive behavioral program for patients with depression or anxiety disorders

The authors examined the clinical effectiveness of a comprehensive cognitive behavior therapy (CBT) program offered to patients with depression or anxiety disorders. They also tested the prediction, based on Young's schema-focused approach to therapy, that endorsement of maladaptive cognitive schemata predicts poor response to standard CBT. One hundred thirty-four consecutive referrals were assessed on a battery of self-report measures at the commencement of the program, and 121 of these patients (90%) completed the program and provided posttreatment data. Two thirds of the patients showed statistically reliable symptom reduction, and half had large effect size (0.8 standard deviations or more) symptom reduction. Contrary to predictions, greater initial endorsement of schemata did not predict poor therapy response. The CBT program was effective for most patients, including patients with high endorsement of maladaptive schemata.

Assessing the multidimensionality of the 12-item General Health Questionnaire

The present study assessed a variety of factor structures identified by various authors as underlying the 12-item General Health Questionnaire and proposed an alternative structure based on an analysis of item content. Using confirmatory factor analytic techniques (LISREL), the data indicated that the presently proposed factor structure, comprising three factors (Self-esteem, Stress, and successful Coping), fits better than structures previously identified. The findings contribute to understanding of the 12-item General Health Questionnaire by separating Self-esteem and Stress, two dimensions often treated as one factor, and by identifying a third dimension of Successful Coping which is proposed to reflect individuals' perceived efficacy in interacting with the environment.

Age and cognitive impairment influence the performance of the General Health Questionnaire

The General Health Questionnaire (GHQ) is a screening instrument designed to detect nonpsychotic psychiatric disorders. Its discriminating ability can be influenced by factors such as the presence of physical illness, comorbidity with other psychiatric disorders, and the presence of cognitive impairment, which are more frequent in the elderly. The present study examines the influence of age and cognitive impairment on the performance of the GHQ-12, and was performed in the course of a family study designed to evaluate the risks for dementia, depression, and geriatric depression in the relatives of elderly subjects with dementia of Alzheimer type or major depression. Four hundred subjects who had completed the GHQ-12 were included. Test performance was evaluated by receiver-operating characteristic (ROC) analysis. Our results indicate that (1) the GHQ-12 is applicable to elderly subjects (>65 years), (2) its performance is comparable in different age groups, (3) the cutoff value for case identification is higher in the elderly (3/4) compared with younger individuals (1/2) and (4) mild cognitive impairment does not influence the good performance of the GHQ-12 in elderly subjects. In conclusion, our study verifies the usefulness of the GHQ-12 as an instrument to identify states of depression; this applies also to subjects with mild intellectual impairment. To optimize the discriminative ability of the questionnaire, we propose the use of different cutoff values for the GHQ-12 score for case identification depending on the age of each individual.